EyeWorld Asia-Pacific September 2012 Issue

3 EWAP September 2012 Letter from the Editor Dear Friends R efractive surgery can be challenging, particularly when we encounter patients who have had previous corneal or refractive procedures. Patients who have had penetrating keratoplasty, particularly for keratoconus, are often left with residual astigmatism, which can be addressed in several ways. Traditionally, astigmatic keratotomy either within the bed of the graft–host interface or within the donor cornea has been the mainstay of reducing astigmatism. Unfortunately, the corneal biomechanics following keratoplasty are unpredictable due to scarring at the interface. Personally, I have found that relaxing incisions in the graft–host interface can be very helpful in addressing large amounts of astigmatism if this is performed with real-time monitoring using a surgical keratoscope. This, however, does not address the spherical equivalent error which requires either LASIK or PRK. There appears to be a trend to using surface ablation with the addition of mitomycin rather than LASIK and this can be sufficient to manage post-keratoplasty refractive error when the astigmatism is relatively moderate. Progressive hyperopia and unstable refractive error are commonly encountered in patients who have had radial keratotomy, sometimes decades earlier. These patients are often surprisingly tolerant of their poor vision and attempts have been made to correct this either with LASIK or surface ablation with mitomycin. The results have been quite variable and often lens/cataract surgery is the preferred approach as the cornea is not subjected to further surgery. Crosslinking is a new method that is now available to strengthen the cornea to reduce progressive ectasia due to keratoconus or post LASIK. Progress is being made with alternative solutions and methods of applying UV radiation which may enable shorter treatments without removing the epithelium, thus reducing complications. Finally, the journal contains some very valuable insights from experienced refractive surgeons on how to manage unhappy patients. The common thread in all the comments from our panel of experts is the importance of communication. This includes careful selection and providing appropriate information to people considering refractive surgery as well as managing any issues that may arise following a procedure. Although to the uninitiated refractive surgery may appear to be relatively straightforward, the discipline often embraces situations where appropriate management is poorly defined and solutions are still being established. Sharing information on how different physicians approach these problems is so important in determining the best way forward. Publications such as EyeWorld Asia-Pacific play an important role in this process and I am sure we will all benefit from the expert advice contained in this month’s issue from our colleagues on how to manage challenging problems in refractive surgery. Warmest regards Graham Barrett, MD President, APACRS Chief Medical Editor, EyeWorld Asia-Pacific EYEWORLD ASIA-PACIFIC EDITORIAL BOARD C HIEF MEDICAL EDITOR Graham BARRETT, Australia MEMBERS Abhay VASAVADA, India ANG Chong Lye, Singapore CHAN Wing Kwong, Singapore CHEE Soon Phaik, Singapore Choun-Ki JOO, Korea Hiroko BISSEN-MIYAJIMA, Japan ASIA-PACIFIC CHINA EDITION Editors-in-Chief ZHAO Jialiang ZHAO Kan Xing Deputy Editor HE Shouzhi ASIA-PACIFIC INDIA EDITION Regional Managing Editor S. NATARAJAN ASIA-PACIFIC KOREA EDITION Regional Editor-in-Chief Hungwon TCHAH Regional Managing Editor Chul Young CHOI Hung-won TCHAH, Korea John CHANG, Hong Kong Johan HATAURUK, Indonesia Kimiya SHIMIZU, Japan Pannet PANGPUTHIPONG, Thailand Prin ROJANAPONGPUN, Thailand Ronald YEOH, Singapore S. NATARAJAN, India YAO Ke, China YC LEE, Malaysia